PMID- 28762511
OWN - NLM
STAT- MEDLINE
DCOM- 20180129
LR  - 20181202
IS  - 1525-1594 (Electronic)
IS  - 0160-564X (Linking)
VI  - 41
IP  - 11
DP  - 2017 Nov
TI  - Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During 
      Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.
PG  - E263-E273
LID - 10.1111/aor.12942 [doi]
AB  - To date, no consensus exists regarding indication, technique, or efficacy of 
      distal perfusion cannulae (DPC) in preventing limb ischemia among patients 
      receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aim to 
      examine the available literature and report association between DPC and risk of 
      limb ischemia. PubMed/Medline, Scopus, Cochrane Central Register of Controlled 
      Trials, Google Scholar, and bibliographies of included studies were searched from 
      database inception until August 2016. Original studies describing the DPC 
      placement technique and incidence of limb ischemia following DPC placement among 
      VA-ECMO patients were included for systematic review. Studies with a comparison 
      group of patients without DPC were included for meta-analysis. Two authors 
      independently screened title/abstracts, reviewed full texts, and extracted data 
      from the eligible studies. Meta-analysis was performed using the Mantel-Haenszel 
      method under a random-effects model. Statistical heterogeneity was examined with 
      the I2 statistic (RevMan Version 5.3). Of 542 title/abstracts screened, 62 full 
      text articles were selected for review, yielding 22 retrospective observational 
      studies, for a total of 779 patients with 132 limb ischemia events. There was 
      significant variation in DPC indication, cannula type, and placement technique 
      among the studies. Compared to no DPC, the presence of a DPC was associated with 
      at least a 15.7% absolute reduction in the incidence of limb ischemia (9.74 vs. 
      25.42%; risk ratio 0.41; 95% confidence interval 0.26-0.65, P < 0.01; 
      heterogeneity statistic I2 = 28%). There was no statistically significant 
      difference in mortality in the pooled dataset comparing DPC versus no DPC. In 
      adults treated with VA-ECMO, DPC placement was associated with a lower incidence 
      of limb ischemia. Currently no consensus guidelines exist regarding indication 
      for DPC placement. Given the association described in this analysis, future 
      prospective trials are warranted to establish a causal relationship and optimal 
      technique for the use of DPC in patients treated with VA-ECMO.
CI  - (c) 2017 International Center for Artificial Organs and Transplantation and Wiley 
      Periodicals, Inc.
FAU - Juo, Yen-Yi
AU  - Juo YY
AUID- ORCID: 0000-0003-4195-2481
AD  - Department of Surgery, University of California, Los Angeles, CA.
AD  - Center for Advanced Surgical and Interventional Technology (CASIT), University of 
      California, Los Angeles, Los Angeles, CA.
AD  - Department of Surgery, George Washington University, Washington, DC.
FAU - Skancke, Matthew
AU  - Skancke M
AD  - Department of Surgery, George Washington University, Washington, DC.
FAU - Sanaiha, Yas
AU  - Sanaiha Y
AD  - Department of Surgery, University of California, Los Angeles, CA.
FAU - Mantha, Aditya
AU  - Mantha A
AD  - Medical School, University of California, Irvine, Irvine, CA, USA.
FAU - Jimenez, Juan C
AU  - Jimenez JC
AD  - Department of Surgery, University of California, Los Angeles, CA.
FAU - Benharash, Peyman
AU  - Benharash P
AD  - Department of Surgery, University of California, Los Angeles, CA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170801
PL  - United States
TA  - Artif Organs
JT  - Artificial organs
JID - 7802778
SB  - IM
MH  - Chi-Square Distribution
MH  - Equipment Design
MH  - Extracorporeal Membrane Oxygenation/adverse effects/*instrumentation/mortality
MH  - Extremities/*blood supply
MH  - Humans
MH  - Ischemia/etiology/mortality/physiopathology/*prevention & control
MH  - Odds Ratio
MH  - Perfusion/adverse effects/*instrumentation/mortality
MH  - Regional Blood Flow
MH  - Risk Factors
MH  - Treatment Outcome
MH  - *Vascular Access Devices
OTO - NOTNLM
OT  - -Extracorporeal membrane oxygenation
OT  - -Intensive care
OT  - -Limb ischemia
OT  - Distal perfusion cannula
EDAT- 2017/08/02 06:00
MHDA- 2018/01/30 06:00
CRDT- 2017/08/02 06:00
PHST- 2016/12/06 00:00 [received]
PHST- 2017/02/20 00:00 [revised]
PHST- 2017/03/03 00:00 [accepted]
PHST- 2017/08/02 06:00 [pubmed]
PHST- 2018/01/30 06:00 [medline]
PHST- 2017/08/02 06:00 [entrez]
AID - 10.1111/aor.12942 [doi]
PST - ppublish
SO  - Artif Organs. 2017 Nov;41(11):E263-E273. doi: 10.1111/aor.12942. Epub 2017 Aug 1.